[Deprivation index by enumeration district in Spain, 2011]

OBJECTIVE

To present the methodology used in the design and implementation of a deprivation index by enumeration district, and to describe the socioeconomic situation of Spain in 2011.

METHOD

The unit of analysis was the enumeration district (N=35,960). Data came from the 2011 Population and Housing Census of Spain. Given both the sampling nature of the Census and the regulatory limitations of data confidentiality, variables were calculated indirectly by using the complement of the available variables. Checks were made to ensure reliability. The selection of the indicators took into account comparability with the MEDEA index. The inclusion of additional information was explored. A deprivation index was built using Principal Component Analysis. Sensitivity analysis of the index was performed for urban areas and the rest of the regions.

RESULTS

Using the census information, 22 indicators were calculated for 35,917 enumeration districts. The deprivation index was based on six indicators: manual and temporary workers, unemployment, insufficient education overall and in young people (aged 16 to 29 years), and dwellings without access to the internet. The map of Spain shows a gradient of decreasing deprivation from south-west to north-east.

CONCLUSIONS

The socioeconomic information of the 2011 census by enumeration district was used systematically. The drafted index, similar to the MEDEA, will facilitate the updated study of health inequalities for Spain overall following the economic recession that began in 2008.

Diabetes mellitus mortality in Spanish cities: Trends and geographical inequalities

AIM

To analyze the geographical pattern of diabetes mellitus (DM) mortality and its association with socioeconomic factors in 26 Spanish cities.

METHODS

We conducted an ecological study of DM mortality trends with two cross-sectional cuts (1996-2001; 2002-2007) using census tract (CT) as the unit of analysis. Smoothed standardized mortality rates (sSMR) were calculated using Bayesian models, and a socioeconomic deprivation score was calculated for each CT.

RESULTS

In total, 27,757 deaths by DM were recorded, with higher mortality rates observed in men and in the period 1996-2001. For men, a significant association between CT deprivation score and DM mortality was observed in 6 cities in the first study period and in 7 cities in the second period. The highest relative risk was observed in Pamplona (RR, 5.13; 95% credible interval (95%CI), 1.32-15.16). For women, a significant association between CT deprivation score and DM mortality was observed in 13 cities in the first period and 8 in the second. The strongest association was observed in San Sebastián (RR, 3.44; 95%CI, 1.25-7.36). DM mortality remained stable in the majority of cities, although a marked decrease was observed in some cities, including Madrid (RR, 0.67 and 0.64 for men and women, respectively).

CONCLUSIONS

Our findings demonstrate clear inequalities in DM mortality in Spain. These inequalities remained constant over time are were more marked in women. Detection of high-risk areas is crucial for the implementation of specific interventions.

Injuries Among Immigrants Treated in Primary Care in Madrid, Spain

This study compared the injury incidence rates by sex in adult immigrant and native population attended in primary care in the Community of Madrid, Spain. Cross-sectional study of injuries registered in the primary care electronic medical record in 2012. Crude and age-adjusted incidence rates by sex, region of birth and type of injury were calculated. Poisson regression was performed. In both sexes, the highest crude injury incidence rate was found in immigrants from North Africa, followed by the native population. After controlling for age and socioeconomic-status, the highest risk of injury in immigrants was observed in burns in women from North-African (79%) and in foreign body injuries in men from Latin America and Caribbean, Sub-Saharan and North Africa and Central and Eastern Europe (61-123%). The analysis by region of origin has identified people from North Africa as a particularly vulnerable group.

Age and gender differences in Clostridium difficile-related hospitalization trends in Madrid (Spain) over a 12-year period

This study aimed to analyze temporal trends by gender and age in Clostridium difficile infection (CDI)-related hospitalization rates in the Autonomous Community of Madrid (Spain) over a 12-year period. A population-based cross-sectional study of all hospital admissions with a CDI diagnosis from 2003 to 2014 was carried out. Annual age-specific hospitalization rates were calculated by gender. All the analyses were performed separately for total hospitalizations and hospitalizations with CDI as the primary diagnosis. Joinpoint regression models were used to analyze time trends. A total of 13,526 hospital discharges were identified (26.8 % with CDI as the primary diagnosis). In both sexes, a gradient in age-specific rates was observed, ranging in 2014 from 5.92 hospitalizations per 100,000 person-years in patients <15 years of age to 378.96 in patients ≥85 years of age. Since 2009, in the age group of 15-44 years, both men and women presented an increasing trend of around 18 %. A significantly increasing trend was detected in women of age 45-84 years, with an estimated annual percentage of change of 7.6 % in the age group of 45-64 years, and rounding with 4.5 % in the age group of 65-84 years. In men of age 45-64 years, the average annual percentage of increase was 4.7 %, and it was 21.1 % between 2010 and 2014 in the age group of 65-74 years. No trends were identified in the 85 years and over age group. Surveillance methods to assess trends by age group should be implemented. Preventive and therapeutic initiatives should remain a priority.

Coverage of and factors associated with pneumococcal vaccination in chronic obstructive pulmonary disease

SETTING

Patients aged ⩾ 40 years with a diagnosis of chronic obstructive pulmonary disease (COPD; codes R95, R79 and R91 in the International Classification for Primary Care) registered in primary care clinical records in the Autonomous Community of Madrid, Spain.

OBJECTIVE

To assess pneumococcal vaccination coverage in patients with COPD and to analyse factors associated with vaccination uptake.

DESIGN

Population-based cross-sectional study in which data were collected in September 2010.

RESULTS

We found that 93,797 patients (72.0% men and 28.0% women) had COPD. Overall coverage was 65.5% (67.5% men vs. 60.4% women, P < 0.001). In patients aged 40-59 years, coverage was 19.5%, reaching 75.8% in those aged ⩾ 60 years. In patients aged <60 years, uptake was associated with a higher number of comorbidities and appropriate adherence to seasonal influenza and pandemic vaccination schedules. In patients aged ⩾ 60 years, factors associated with uptake in both sexes were older age and appropriate adherence to seasonal influenza vaccination schedules. Factors associated with uptake in men were concomitant comorbidities and pandemic vaccination.

CONCLUSION

Vaccination coverage in individuals aged <60 years with COPD is less than acceptable in Madrid. Coverage was higher in men and in patients with another chronic condition.

Factors Associated to a Reactive Result of Rapid-HIV Test in Socio-culturally Adapted Services in Primary Care in Spain

The Services of Prevention and Early diagnosis of HIV in Madrid (Spain) are set in selected primary care centers. Cultural mediators targeted to vulnerable groups (economic immigrants, MSM, sex workers…) perform risk assessment and counselling. Between 2010 and 2014 they performed 6 039 rapid-HIV test, 27.8 % in MSM, 41.2 % in men who have sex exclusively with women (MSW) and 31.0 % in women; 35.7 % in immigrants, mainly from Latin America. A reactive result was more common among MSM (6.0 %) compared to women (0.6 %) and MSW (0.5 %). In MSM it was associated to being immigrant and to antecedents of sexually transmitted infections (STI). Among MSW the factors associated to a reactive result were: seropositivity of sexual partner and heroine consumption, and in women: infrequent use of condoms, seropositivity of sexual partner and antecedents of STI. Preventive interventions to reduce risk of HIV transmission and for early detection should be adapted and targeted to high risk population.

Dealing with Ebola virus disease in Spain: epidemiological inquiries received by the Department of Public Health Alerts, April to December 2014

We describe the inquiries regarding Ebola virus disease (EVD) received by the Department of Public Health Alerts of the Community of Madrid between April and December 2014. A total of 242 inquiries were received. Consultations were initiated most frequently by hospital clinicians (59 inquiries, 24%), private citizens (57 inquiries, 24%) and primary care physicians (53 inquiries, 22%). The most frequent topic of inquiry was possible EVD in a patient (215 inquiries, 89%). Among these, 31 persons (14%) presented both EVD-compatible symptoms and epidemiological risk factors, and 11 persons (5%) fulfilled the criteria for a person under investigation. Recent travel abroad was reported in 96 persons (45%), but only 32 (15%) had travelled to an EVD-affected area. Two high-risk and one low-risk contact were identified through these inquiries. Low specificity of the EVD symptoms led to many difficulties in protocol application. Ineffective communication with healthcare professionals and unfamiliarity with the EVD protocols caused many case classification errors. A rapid consultation service by telephone is essential for providing qualified advice during emergencies. Our experience may help other countries dimension their activities and resources for managing similar exceptional outbreaks in the future.

Increase in socioeconomic inequalities in mortality in a Southern European region: a small-area ecological study

BACKGROUND

This study sought to describe the total mortality trend by socioeconomic deprivation (SED) in the Madrid Autonomous Region, by sex and age group.

METHODS

Cross-sectional ecological study by census tract, in two periods: 1994-2000 (P1) with SED of 1996 census and 2001-07 (P2) with SED of 2001 census. We calculated the relative risks (RRs) and their 95% credibility intervals (95% CIs) by SED quintile (Q), taking the quintile of least deprivation as reference. Besag-York-Mollié ecological regression models and the Integrated Nested Laplace Approximation procedure were applied. The absolute differences in age-standardized rates were compared by SED quintile.

RESULTS

Inequalities decreased in young adults: among men aged 20-39 years, the RR in Q5 versus Q1 ranged from 2.73 (95% CI, 2.51-3.02) in P1 to 1.93 (95% CI, 1.76-2.15) in P2, due to the greater improvement in the most underprivileged groups. In contrast, there was an increase in SED-related mortality in the 40-79 age group. Among men aged 40-59 years, the RR in Q5 versus Q1 rose from 1.88 (95% CI, 1.76-2.02) in P1 to 2.29 (95% CI, 2.17-2.43) in P2; the improvement was greater in the most privileged groups.

CONCLUSION

In a context of an economic boom, inequalities were observed to increase among adults by a greater improvement in the most privileged groups.

Temporal trends in incidence rates of herpes zoster among patients treated in primary care centers in Madrid (Spain), 2005-2012

OBJECTIVES

This study aimed to estimate total and age-specific incidence rates of HZ with data from electronic clinical records in primary care (ECRPC) and to analyze trends by sex and age.

METHODS

Descriptive cross-sectional study covering the incident HZ episodes registered in the ECRPC of the Madrid Regional Public Health System in 2005-2012. Annual crude and age-adjusted incidence rates were calculated. Differences by sex and age were assessed by poisson regression. The annual percentage of change (APC) of incidence rates and 'breakthrough points' of the time trends were determined with the Joinpoint Regression Program.

RESULTS

211,650 episodes of HZ were identified (60.6% women, 52.2% > 55 years). The incidence rate increased from 363.21 to 481.92 per 100,000 person-year in 2005-2012. Rates were higher among women and increased with age. The APC for the period was 3.59% in men and 3.67% in women (p < 0.05). Age-specific rates increased in patients over 14 years. The APC in the 25-44 age group was 7.4% since 2007. The incidence rate ratio (women/men) was highest in this group.

CONCLUSIONS

The incidence of HZ presents an upward trend in 2005-2012 in adults and the elderly. Monitoring the incidence and age-specific rates, will help to detect changes in trends.

Census tract socioeconomic and physical environment and cardiovascular mortality in the Region of Madrid (Spain)

BACKGROUND

Features of the area might contribute to differences in cardiovascular mortality. The census tract distribution of ischaemic heart disease (IHD) and cerebrovascular disease mortality in the Region of Madrid and its association with deprivation and environmental variables were examined in this study.

METHODS

Cross-sectional, ecological study covering 3906 census tracts (median of around 1000 inhabitants), using mortality data (population aged <75 years) for 1996-2003, as well as socioeconomic deprivation and other environmental indicators (subjective perceptions of pollution, background noise, lack of green spaces and delinquency) drawn from the 2001 census. Standardised mortality ratios were calculated. Smoothed census tract relative risks were calculated using the Besag-York-Mollié model. Relative risks (RRs) of dying and their 95% credibility intervals (95% CI) were calculated according to the indicators considered (with the fourth quartile, Q, being the most unfavourable situation). Maps were plotted depicting the distribution of the posterior probability of RR>1.

RESULTS

Census tracts with excess mortality were mostly located in the city of Madrid. Mortality increased with deprivation: RRs of IHD and stroke mortality in Q4 with respect to Q1 were 1.42 (95% CI 1.31 to 1.54) and 1.66 (95% CI 1.45 to 1.88) for men, and 1.54 (95% CI 1.33 to 1.79) and 1.52 (95% CI 1.29 to 1.76) for women respectively. Associations with deprivation decreased only slightly when perceived lack of green spaces and delinquency were included in the model. In men, subjective perceptions of areas remained associated with cardiovascular mortality after adjustment for deprivation.

CONCLUSION

Deprivation and subjective perceptions of physical environmental characteristics are ecologically associated with cardiovascular disease mortality.

Epidemiological usefulness of population-based electronic clinical records in primary care: estimation of the prevalence of chronic diseases

BACKGROUND

Chronic health problems are the main cause of disease, disability and death in developed countries, and their prevalence is increasing.

OBJECTIVE

To estimate the prevalence of selected chronic illnesses based on electronic clinical records in primary care (ECRPC) and to assess its usefulness for epidemiological research, by comparing ECRPC data against those reported by a contemporary health survey.

DESIGN

Descriptive cross-sectional study.

SETTING

All primary care medical consultations in the Madrid Regional Public Health System (PHS).

SUBJECTS

A total of 23 535 182 ECRPC-registered episodes of illness, generated by PHS patients over 15 years of age seeking medical care during 2005-06.

MAIN OUTCOME MEASURES

Prevalences of chronic diseases estimated on the basis of medically examined cases registered in ECRPC and morbidity as reported by a contemporary health survey covering the same geographic area.

RESULTS

A total of 52.5% of the adult population had some chronic health problem. The highest overall prevalences were hypertension (14.8%), mental disorders (12.0%) and allergy (11.6%). Prevalences were generally highest among women, elderly and the native population. Depending on the specific disease, ECRPC-based prevalences were similar to (e.g. diabetes), higher (e.g. chronic skin problems) or lower (e.g. asthma and dyslipidaemia) than those reported by surveys, with certain age- and sex-related variations.

CONCLUSIONS

Prevalences estimated from ECRPC and survey data present variations depending on the disease, age and sex. Both data sources provide complementary information about chronic disease prevalence. ECRPC have the advantage of generating an ongoing standardized register and entailing no additional effort for health professionals.

Adenovirus Transmission in a Nursing Home: Analysis of an Epidemic Outbreak of Keratoconjunctivitis

BACKGROUND

An epidemic outbreak of keratoconjunctivitis occurred in a nursing home in Madrid from August to December 2005.

OBJECTIVE

This article reports the outbreak, the infection control measures taken, and risk factors for keratoconjunctivitis.

METHODS

A cohort study was conducted on the nursing home staff and residents. Specific attack rates and relative risks with their 95% confidence intervals were estimated. A multivariate analysis (logistic regression) was performed proving odds ratios (OR) of becoming ill. Conjunctival swab samples were taken and tested for viral infection. More stringent infection control measures were implemented following the occurrence of the initial cases.

RESULTS

Forty-six cases were identified in the nursing home (infection rates of 30.5% in residents and 8.3% in workers). Total duration of the outbreak was 120 days. Corneal ulcer occurred in 3 cases. The factors appearing as independent risk factors were age (OR = 5.7 in people aged >or=90 years compared to those aged <80 years), cognitive impairment (OR = 2.64) and nursing home floor (OR = 2.74 for the first floor, where the outbreak started). Adenoviral DNA was amplified in 10 samples, and 8 of them could be typed as adenovirus serotype 8.

CONCLUSIONS

Early adoption of adequate hygiene measures is essential to control these outbreaks. In nursing homes with a high number of people with cognitive impairment, an additional effort should be made when the first cases occur to provide such people an increased and improved care and monitoring.

[Shared surveillance: meningococcal disease vs influenza]

OBJECTIVE

To analyse the association between the behavior of meningococcal disease and influenza, using for this purpose population statistics for Spain for the period of 1964 to 1997.

METHODS

Ecological study of the incidence of meningococcal disease and influenza in Spain from 1964 to 1997, inclusive. The study used weekly statistical data for these diseases supplied by the Compulsory Disease Reporting System (Enfermedades de Declaración Obligatoria, EDO). The deterministic component of the meningococcal disease and influenza series was studied by means of spectral analysis based on the Fast Fourier Transformation, and the non-deterministic component was studied using the ARIMA model. The Box-Jenkins method was used for pre-bleaching the series, and a cross-correlation was subsequently established between the residuals in order to detect the presence of any significant correlations between the meningococcal disease and influenza series.

RESULTS

During the period from 1964 to 1997, the week that showed, on average, the greatest number of cases for the season was week 7 in the case of meningococcal disease and week 6 in the case of influenza. Spectral analysis of the meningococcal disease and influenza series clearly demonstrated the annual periodicity of both series, and periodicity of nearly 11 years for meningococcal disease and slightly over 10 years for influenza. When cross-correlation is established after prebleaching the series, positive correlations are obtained in the results of lags 0, 1, 2, and 3. Introducing influenza as an exogenous variable in the multivariate model of meningococcal disease corroborates these results. There was a statistically significant relationship between the two processes during the same week and with a three-week lapse.

CONCLUSIONS

By means of a methodology not previously applied to this subject, and by the use of prolonged time-span, country-comprehensive population statistics (which includes several epidemics waves), an association was shown to exist between meningococcal disease and influenza. This suggests the need for the surveillance of the two processes in an interrelated manner.

Infant and perinatal mortality in Spain 1981-1991: interprovincial variations in Autonomous Communities with extreme economic levels

The aims of the present study were to describe and compare infant, neonatal, postneonatal and perinatal mortality in aggregates of Spanish Autonomous Communities (AC) with higher and lower income, as well as to describe and compare their respective inequalities among the provinces constituting AC with similar (high or low) and with extreme economic levels, over the period from 1981 to 1991. The coefficient of variation (weighted by the number of births) has been used as the measure of interprovincial inequalities in mortality within each aggregate of AC and time trends in the average mortality rates and in their coefficients of variation have been analyzed using simple linear regression. The results of the study confirmed that the four mortality rates were all higher in the aggregate of AC of lower income than in that of higher income, and have fallen in both in a similar manner. Thus the perinatal mortality rates for the lower and higher income aggregates of AC respectively were 17.3 and 12.5 per 1000 births in 1981, and 8.3 and 6.8 in 1991. The inequality in postneonatal mortality was dominant in the group of AC with a lower economic level whereas geographical inequalities in perinatal mortality predominated in the higher income group. The predominance of interprovincial inequalities in perinatal mortality when all the AC (with extreme economic levels) were considered suggest that economic factors are closely related to perinatal mortality.

[Habitual physical activity in a population residing in the city of Barcelona]

OBJECTIVES

To describe the sociodemographic distribution of habitual physical activity and to analyse its relationship with self-perceived health status and occupational status, among the population older that 16 years of age in the city of Barcelona, Spain.

METHODS

A sample of 1,885 adult men and 2,196 women answered the Health Interview Survey of Barcelona in 1992. Those whose habitual activity required high physical exertion or walking were considered as active. Bivariate and multivariate analyses adjusting logistic regression models were used to study the relationship between habitual physical activity and the rest of variables, for each occupational situation.

RESULTS

Fifty six percent of adults reported being physically active. Physical activity was lower among workers than non workers, although workers reported more physical exertion (14.5% in men and 8.0% in women). Physical activity was associated with occupation and educational level among male workers, but only with occupation among female workers. In the non working population, physical activity was lower among those who perceived their health status as fair or poor, compared with those that described it as good or very good, (ORa in men was 0.2, 95% confidence interval = 0.1-0.5; ORa in women was 0.5, 95% confidence interval = 0.3-0.8).

CONCLUSIONS

More than half of the Barcelona population were physically active in an habitual manner. Among workers, this activity was mainly determined by the occupation. Non-workers with a poor self-perceived health status did less physical activity.

[Leisure time physical activity and its association with demographic variables and other behaviors related with health]

OBJECTIVES

To describe leisure-time physical activity at the levels considered more beneficial for health and to analyze the association with sociodemographic variables and other health behaviors, among the population older than 14 years in Barcelona, Spain.

METHODS

A sample of 4,171 adults answered the Health Interview Survey of Barcelona in 1992. Those who had participated less than three times (20 minutes at least) in moderate and/or intense exercise in the week before to the interview were considered inactive. Bivariate and multivariate analyse using logistic regression were used to study the association of leisure-time physical activity and the study variables.

RESULTS

80.7% of population older than 14 years in Barcelona participated less than three times in moderate and/or intense leisure-time physical activity and 20% did not participate in any exercise. Inactivity was higher in women, and increased significantly with age and in people with a low socioeconomic level. Men and women with incomplete primary studies were more likely to be inactive than people with graduate studies (ORa-adjusted odds ratio-1.8, 95% confidence interval-CI-: 1.1-2.9 and 1.5, 95% CI: 1.0-2.4 respectively). For men working eight or more hours with interruption per day the ORa for inactivity was 1.9 (95% CI: 1.2-2.9) with respect to men working less than eight hours without interruption. Smoking men were more inactive than non smokers.

CONCLUSIONS

These result suggest that health promotion programmes to promote physical activity for adult in Barcelona should facilitate the incorporation of older people, women, people with low socioeconomic level and the working population, besides reinforcing sports habits among the youngest population.